Riaz Haq writes this data-driven blog to provide information, express his opinions and make comments on many topics. Subjects include personal activities, education, South Asia, South Asian community, regional and international affairs and US politics to financial markets. For investors interested in South Asia, Riaz has another blog called South Asia Investor at http://southasiainvestor.blogspot.com and a YouTube video channel https://www.youtube.com/channel/UCkrIDyFbC9N9evXYb9cA_gQ

Monday, December 12, 2011

Is India Safe For Medical Tourism?

A deadly hospital fire claiming 91 patients' lives in India last week is raising serious concerns about the safety of foreigners being wooed by the nation's growing medical tourism industry.

The fire swept through AMRI, a 180-bed, state-of-the-art facility regarded as one of the best hospitals in India. There were no exit doors or evacuation plan, the windows were sealed, and the local fire department took more than 90 minutes to arrive. Trapped, many of the patients died from smoke inhalation, according to a report in Christian Science Monitor. Most died in their beds, unable to escape the inferno that raged for hours. Residents living in the neighborhood accused the hospital guards of not taking any measures to control the fire and of even preventing others from rushing to the rescue of the victims who were abandoned by the hospital staff. The hospital is known to attract many foreign patients. However, it's too early to tell if any foreigners died in the blaze because most of the charred remains have yet to be identified.

“Large numbers of hospitals are coming up in a big way across India. What we need to look into when issuing the licenses for running the hospitals is that building construction has complied to safety building codes and a safety plan is in place in case of fire,” said Dr. Muzzafer Ahmed, a member of the country's National Disaster Management Authority, speaking to the media.

Though Indians remain among the most under-served in the world in terms of health care, growing for-profit Indian hospital industry has been promoting itself as an inexpensive alternative to high-cost surgery in the United States and Europe. There are a large number of foreign-trained highly-skilled physicians and surgeons in India. And the heart bypass surgery that costs $6,000 in India costs more than $20,000 in the US, according to Yaleglobal. There are similar deep discounts available for joint replacement, in vitro fertilization (IVF), and surrogate mothers' womb rental services.

Many Indians are expecting exponential growth in foreign demand to take advantage of the opportunity to combine medical treatment with vacations at significantly lower costs. "With health care costs going north," says Dr Alok Roy of Fortis Hospital, one of the leading service providers in the medical tourism sector, "patients are compelled to look at cost-effective destinations for medical treatments. And what could be better if they can combine that with sightseeing at scenic locations?"

The safety concerns about India go beyond the fear of being burned in a fire. Other major concerns include:

1. Fake pharmaceuticals are a big worry. In fact, 75 percent of counterfeit drugs supplied world over have origins in India, according to a report released by the Organization for Economic Co-operation and Development (OECD).

2. Lack of proper hygiene contributes to a large number of infections in hospital settings. A recent investigation into the death of 13 women in a Rajasthan hospital found that the poor hygiene standard in the hospital were flagrantly overlooked, according to Times of India.

Will the latest incident at AMRI in Kolkatta, combined with general concerns about unhygienic practices and widespread use of fake pharmaceuticals, hurt India's efforts at growing its medical tourism industry? The short answer is yes. However, the growth prospects could improve in the future when the Indian government and the hospital industry begin to improve the safety situation to regain the trust of prospective foreign customers.

25 comments:

Not a bad idea to raise a report to state that it is subotage of pakistan and divert the attention toward the enemy. Generally that is the style of pakistan and not india.

@riaz

NO medical tourist comes to the government hospital. They go to private sector hospital which has five star comfort with seven star bills. But from their perspective it is still cheaper. You could read here and there even Pakistani coming over to India for treatment.

http://sociologyindex.com/medical_tourism_in_india.htm

Nothing will happen after this fire as government hospital are place for the mp / mla to loot the fund by supplying substandard equipments and infrastructure.

EXPECTATIONS for India’s economic growth rate have been sliding inexorably. In the early spring there was still heady talk about 9-10% being the new natural rate of expansion, a trajectory which if maintained would make the country an economic superpower in a couple of decades. Now things look very different. The latest GDP growth figure slipped to 6.9% and industrial production numbers just released, on December 12th, showed a decline of 5.1% compared with the previous period, a miserable state of affairs. The slump looks broadly based, from mining to capital goods, and in severity compares with that experienced at the height of the financial crisis, in February 2009, when a drop of 7.2% took place. Bombast is turning to panic.

Seven UAE-funded hospitals and clinics will be built in Pakistan at a cost of nearly Dh63 million, Wam, the state news agency, reported yesterday.

After a signing ceremony between Abdullah Khalifa Al Ghafli, director of Emirati projects to assist Pakistan, and Maj Gen Zahir Shah, commander of the GOC 45th Engineers Division of the Pakistani Armed Forces, it was announced that two hospitals will be built under the names of Sheikh Khalifa and Sheikha Fatima.

Mr Al Ghafli said the UAE would also fund medical equipment for both hospitals and all of the clinics.

The increasing number of healthcare projects in Pakistan was a sign of the strong co-operation between Pakistan and the Emirates, said Sheikha Fatima bint Mubarak, chairwoman of the General Women's Union and of the Family Development Foundation.

"Pakistan was one of the first three countries in the world to recognise the UAE, following the declaration of the Union on December 2, 1971," she said.

Sheikha Fatima said the active role the UAE plays in places of crisis was due to the generosity of the president, Sheikh Khalifa.

"We thank Allah that when humanitarian work anywhere worldwide is mentioned, the name of the UAE comes up, thanks to its generosity and its strong commitment to shoulder its responsibilities and to preserve human dignity," she said....--------In February of this year, a medical team from the RCA and 400 local volunteers initiated a programme to provide measles and polio vaccines to Pakistani children.

The Campaign to Cure One Million Children, sponsored by Sheikha Fatima, also provided free medical treatment to more than five million children who suffered from malnutrition and digestive and respiratory diseases as a result of the flooding.

The UAE ambassador to Pakistan, Eissa Abdullah Al Nuaimi, noted that last month a UAE-funded school for 400 pupils was completed.

DHAKA: Bangladeshi patient is among the 73 killed so far in the massive fire at AMRI private hospital in Kolkata, the foreign ministry says.

However, a number of foreign and Indian media put the death toll at 90 in the hospital inferno, saying nearby hospitals were providing emergency treatment to the seriously wounded AMRI hospital victims.

The process to bring back the body of Gauranga Mandal through the Bangladesh Deputy High Commission in Kolkata is underway, the South Asia Department director general Mashfi Binte Shams told the reporters.

Family members had identified the body, Shams said.

She, however, did not have Gauranga's address or other information about him immediately.

Nearly 160 patients were admitted in the facility, The Times Of India said quoting hospital sources.

Additional director general, Fire Services, D Biswas was quoted as saying that patients who died were admitted in the critical care and orthopaedic units and were unable to move.

Only 85 patients were rescued and removed to two other units of the same hospital located at Mukundapur and Saltlake, they told the Indian daily. It said the hospital authority could not confirm the condition of remaining 75 patients....

Convincing Americans to jet off to third-world India is a bit of a harder sell, though. By buying a 23.9% stake in Parkway from U.S. private equity firm TPG for $687 million, Fortis has now positioned itself to become the regional leader in medical tourism, with a strong presence in India (where it has 46 hospitals) for the most price-sensitive patients and a new base in Singapore for higher-end customers aiming for more luxury. Investors are pretty upbeat about the deal: Fortis shares today hit a twelve-month high of 187.4 rupees and are up 35% so far this year. Parkway investors are happy, too. The Singapore company hit a 52-week high of 3.3 Singapore dollars today.

Here's an APP report on the use of technology by US to teach and treat in Pakistan:

U.S. Ambassador to Pakistan Cameron Munter Thursday highlighting Pak-US cooperation in science and technology said that it has trained more than 100 doctors nationwide, and treated more than 2,000 patients remotely through the use of cutting-edge technology. During his visit here Thursday the Ambassador and his wife Marilyn Wyatt met with the faculty and students of the Rawalpindi Medical College at Holy Family Hospital’s telemedicine facility, working together with U.S. hospitals.

He said Pak-US cooperation in science and technology focused on many elements, including innovations in Pakistan’s public health sector. During a tour of the hospital with the hospital’s Telemedicine E-Health Training Center Project Director Dr. Asif Zafar, Ambassador Munter stated, “Holy Family’s partnership with American hospitals is an example of the true spirit of our people, who work together, across oceans, to improve access to healthcare in remote areas of Pakistan and treat the sick.” He said, “We commend Dr. Asif Zafar and the Holy Family Hospital team for its efforts to strengthen the health sector in Pakistan, and look forward to more shared successes that bring Pakistanis and Americans closer together.”

Now, the free flow of fake medications channeled through the market for decades may soon be slowed. Lawmakers are poised to pass legislation in June creating an agency to quash the trade after 107 heart patients were killed this year by pills tainted with lethal amounts of an anti-malarial agent. That may help break the ring of counterfeiters in Pakistan, part of a wider network supplying what the World Health Organization estimates is a $431 billion global market for spurious drugs.

The problem spans national borders. Pakistan was one of the 10 largest sources of counterfeit goods seized in the U.S. last year, U.S. Customs and Border Protection said in January. Medicines accounted for 85 percent of the value of the Pakistani items obtained.

At least 30 percent of medicines bought in the country are either counterfeits or substandard, said Kulsoom Parveen, a lawmaker who chairs a Senate health committee. Pharmacies nationwide sell drugs without a doctor’s prescription, enabling the treatments to be taken without medical supervision.’Exploiting Weaknesses’

It’s no coincidence that fake and substandard drugs are flourishing in Pakistan, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. The New York- based think-tank prepared six recommendations to fight the drug- safety crisis for consideration by the Group of Eight summit at Camp David, Maryland, today and tomorrow.

“Individuals that are exploiting weaknesses in global drug safety and regulation will base themselves in places where they know the system is fragile or nonexistent,” Garrett said in a telephone interview. “Pakistan is really struggling to keep its entire public health infrastructure alive.”Damaging Brands

Protecting product integrity would also benefit makers of brand-name medicines. Pharmaceutical sales in Pakistan, with a population of 196 million, total $2 billion annually, compared with $12.4 billion in neighboring India, with 1.2 billion people.

GlaxoSmithKline Pakistan, based in Karachi, made 1.14 billion Pakistani rupees ($12 million) in profit on sales of 21.75 billion rupees last year. In India, Mumbai-based GlaxoSmithKline Pharmaceuticals Ltd. (GLXO) had net income of 6.3 billion Indian rupees ($118 million) and revenue of 23.9 billion rupees.

Prime Minister Syed Yousuf Raza Gilani’s government hasn’t had a federal health minister or a central drug regulatory agency since powers were handed to the country’s four provinces last year. A new bill, to be voted on by Pakistan’s senate next month, will strive to fill the void....

My Indian friends and I joke around a lot about me as the typical white American guy visiting India. Cows! Con men! Colors! Most people I’ve met in India have restricted their reactions to my westerner-in-the-east experiences to gentle teasing. When I stuck a picture of a man urinating in public on my Facebook page, calling it one more picture of what you see everywhere you go in India, people weren’t as patient. What was I doing? Insulting the nation? Focusing on the ugly because it’s what all the westerners do when they visit India? Why does India provoke such visceral reactions in visitors?

Public urination, public defecation, dirt, garbage, filth, the poor living on the street — talking about these things, even acknowledging that they’re in front of your face, risks making your hosts unhappy, and possibly angry. It’s the third rail of India, and the voltage can be lethal. That’s why I was surprised when B.S. Raghavan decided to touch it with all 10 fingers.

Raghavan’s column in The Hindu Business Line newspaper begins with this headline: Are Indians by nature unhygienic?

Consider these excerpts:

From time to time, in their unguarded moments, highly placed persons in advanced industrial countries have burst out against Indians for being filthy and dirty in their ways of life. A majority of visitors to India from those countries complain of “Delhi belly” within a few hours of arrival, and some fall seriously ill.

There is no point in getting infuriated or defensive about this. The general lack of cleanliness and hygiene hits the eye wherever one goes in India — hotels, hospitals, households, work places, railway trains, airplanes and, yes, temples. Indians think nothing of spitting whenever they like and wherever they choose, and living in surroundings which they themselves make unliveable by their dirty habits. …

Open defecation has become so rooted in India that even when toilet facilities are provided, the spaces round temple complexes, temple tanks, beaches, parks, pavements, and indeed, any open area are covered with faecal matter. …

Even as Indians, we are forced to recoil with horror at the infinite tolerance of fellow Indians to pile-ups of garbage, overflowing sewage, open drains and generally foul-smelling environs.

There’s plenty more that you can read in that story, but I’ll direct you to the article. I’ll also ask you some questions:

Some people say you shouldn’t point out these problems, and that every country has problems. Do you agree with this statement? Why? Does anyone disagree with Raghavan’s descriptions of these sights and smells? Is this even a problem? Or should people get used to it? Should visitors, especially ones from countries where people are generally wealthier, say nothing, and pretend that they don’t see unpleasant things?

As for me, I can say this: I got used to it, but I would be lying if I said I didn’t notice it. Indians notice it too. Otherwise, people wouldn’t suggest public shaming campaigns against people urinating in public, they wouldn’t threaten fines for doing it, and they wouldn’t respond with relief to plans to finally make sure that toilets on India’s trains don’t open directly onto the tracks. Of course, these are people in India. It’s a family, taking care of business the family way.

As for me, the message usually seems to be: “If you don’t love it, leave it.” It would be nice if there were some other answer. Acknowledging problems, even ones that are almost impossible to solve, makes them easier to confront.

On January 7, Japanese actor Yu Asada took a cab from the IGI Airport in Delhi to her hotel in Mahipalpur. It was her maiden trip to India, and she had come to Delhi to meet the cast and crew of My Japanese Niece, a film by Manipuri director Mohen Naorem. That taxi ride was the worst she ever had.

"The cabbie charged me Rs 4,800. When I told him I couldn't pay so much, he talked about the recent gang rape in Delhi and insinuated that I might meet the same fate. I was numb with fear," she told TOI.

American Michelle Tanner (name changed) didn't have to part with her money when she came to India on a backpacking trip in 2010, but she did become a victim of sexual harassment. "Someone pinched my bottom when I went to Chandni Chowk; when I turned around to see who it was, I felt a hand grab my breast. I felt so humiliated that I immediately returned to my hotel, shut myself in my room, and broke down," she said.

Both Asada and Tanner did not approach cops. Neither do the hordes of foreign travellers who face sexual harassment in varying degrees in India. Their reason is simple: when local women with all their familiarity with the law and advantage of language have such a tough time reporting a sexual offence or getting an FIR lodged, what chance do they have as foreigners?

British woman Kaya Enrich, 27, learnt this the hard way when she was molested by a plumber in Gujarat in 2009 and decided to lodge a case. She was allegedly humiliated in a metropolitan court in Ahmedabad. "The questioning was aggressive, and it seemed to be aimed at demeaning me as far as possible so as to weaken the case. I was asked everything in Gujarati and told to answer in Gujarati even though I had asked for an interpreter," she had said back then.

At an even greater disadvantage are those women who don't come from the English-speaking world and, therefore, do not dare move an inch without help from their foreign offices. India doesn't have an enviable reputation for dispensing quick justice; and tourists with their tight itineraries don't want to go through the rigmarole of procedure, never-ending investigations and sanity-defying questions that promise very little comfort.

According to statistics shared by the market research division of the ministry of tourism, 6.65 million tourists came to India last year. Of them, roughly 40% (2.66 million) were women. This figure is likely to go up with India setting a target of increasing its share of arrivals from the current 0.6% to 1% by the end of the 12th plan. This simply means more and more women will come to India, either for work or pleasure, and quite likely, carry home sordid tales of harassment: tales that would eventually find vent in blogs and websites and dent the India story....

Thakur left Kumar's office stunned. He returned home that evening to find his 3-year-old son playing on the front lawn. The previous year in India, the boy had developed a serious ear infection. A pediatrician prescribed Ranbaxy's version of amoxiclav, a powerful antibiotic. For three scary days, his son's 102° fever persisted, despite the medicine. Finally, the pediatrician changed the prescription to the brand-name antibiotic made by GlaxoSmithKline (GSK). Within a day, his fever disappeared. Thakur hadn't thought about it much before. Now he took the boy in his arms and resolved not to give his family any more Ranbaxy drugs until he knew the truth.What Thakur unearthed over the next months would form some of the most devastating allegations ever made about the conduct of a drug company. His information would lead Ranbaxy into a multiyear regulatory battle with the FDA, and into the crosshairs of a Justice Department investigation that, almost nine years later, has finally come to a resolution.On May 13, Ranbaxy pleaded guilty to seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn't meet specifications, and making intentionally false statements to the government. Ranbaxy agreed to pay $500 million in fines, forfeitures, and penalties -- the most ever levied against a generic-drug company. (No current or former Ranbaxy executives were charged with crimes.) Thakur's confidential whistleblower complaint, which he filed in 2007 and which describes how the company fabricated and falsified data to win FDA approvals, was also unsealed. Under federal whistleblower law, Thakur will receive more than $48 million as part of the resolution of the case.Fortune's account of what occurred inside Ranbaxy and how the FDA responded to it raises serious questions about whether our government can effectively safeguard a drug supply that last year was 84% generic, according to the IMS Institute for Healthcare Informatics, much of that manufactured in distant places. More than 80% of active pharmaceutical ingredients for all U.S. drugs now come from overseas, as do 40% of finished pills and capsules. (Click here for a list of Ranbaxy products in the U.S.)2. The dark side of the generics boomToday's global market for generic drugs is $242 billion and growing. In America we have embraced generics as a vital way to control costs, a trend likely only to accelerate as health reform extends treatment to millions and our population ages.Ranbaxy was the first foreign generics manufacturer to sell drugs in the U.S. and rose rapidly to become, today, the sixth-largest generic-drug maker in the country, with more than $1 billion in U.S. sales last year (and $2.3 billion worldwide). The company, now majority owned by Japanese drugmaker Daiichi Sankyo, sells its products in more than 150 countries and has 14,600 employees.

NDM-1 bacteria are propagating most lushly in India. The NDM-1 gene circulates in a family of bacteria called “Gram-negative” (after the Gram test used to identify them) whose unique cell envelopes make them both more toxic and harder to treat than “Gram-positive” bacteria. Many Gram-negative bacteria colonise the human gut and thrive in places with poor sanitation, where gut bacteria can pass from host to host through food and water contaminated with faecal matter. Basic sanitation remains rudimentary in many places in India. Only 65% of Delhi’s sewage is adequately treated and 20% of the population live in overcrowded slums highly exposed to contaminated water and food (9). Uncollected trash and teeming crowds abound just outside Medanta’s gates. Hawkers sell freshly squeezed fruit juice and vegetables from carts and, in a dusty lot next to the hospital, men sit on overturned buckets, eating rice and curry. A narrow stream emerges from near the hospital gates; its weedy banks are lined with trash. In a nearby slum, barefoot children play in narrow alleyways lined by open gutters carrying waste water and excrement.In April 2011 researchers found NDM-1 bacteria in samples of Delhi’s drinking water and in puddles around the city. University of Cardiff microbiologist Tim Walsh suspects that between 100 million and 200 million Indians now carry NDM-1 bacteria in their guts. NDM-1 bacteria flourish at tropical temperatures, so the warm weather and floods of the monsoon season expose even more people.Better healthcare for the poor, improved hospital hygiene and more judicious use of antibiotics could help contain NDM-1. But the politics of national pride may make such measures impossible. Indian medical authorities and politicians have both denied the public health relevance of NDM-1, and accused scientists working on the issue of a “conspiracy to hurt Indian medical tourism”, as The Indian Express put it. After initial reports on the bacteria appeared, Indian government authorities sent threatening letters to Indian researchers who had collaborated with British scientists on NDM-1 studies, according to the UK’s Channel 4 News (10). Walsh, who led many of the studies, said that his Indian collaborators were pressured to disavow their research and he became persona non grata in India: “I’m the devil incarnate and eat babies for breakfast according to the Indian government. It’s a witch hunt.”The Indian government first complained that the bacteria gene was named after their capital city. Then, as the controversy grew, it convened an advisory committee on antibiotic resistance, and floated an ambitious proposal to ban the sale of antibiotics without a physician’s prescription, and restrict the use of last-resort intravenous antibiotics to tertiary hospitals. But after pharmacists went on strike in August 2011, the proposal was withdrawn (11). “The committee was a knee-jerk response,” said Ramanan Laxminarayan, of the Public Health Foundation of India. Wattal, Laxminarayan and others agree that the proposed restrictions would have affected a wide range of drugs besides antibiotics, and would have impeded access to life-saving antibiotics for the rural poor. In fact, the policy had little chance of being enforced: health policy is implemented at state level in India, not federal level.

Here's a Bloomberg story on a tourist's experience with Indian medical system:

Lill-Karin Skaret, a 67-year-old grandmother from Namsos, Norway, was traveling to a lakeside vacation villa near India’s port city of Kochi in March 2010 when her car collided with a truck. She was rushed to the Amrita Institute of Medical Sciences, her right leg broken and her artificial hip so damaged that replacing it required 12 hours of surgery.Three weeks later and walking with the aid of crutches, Skaret was relieved to be home. Then her doctor gave her upsetting news. Mutant germs that most antibiotics can’t kill had entered her bladder, probably from a contaminated hospital catheter in India. She risked a life-threatening infection if the bacteria invaded her bloodstream -- a waiting game over which she had limited control, Bloomberg Markets magazine reports in its June issue.

“I got a call from my doctor who told me they found this bug in me and I had to take precautions,” Skaret remembers. “I was very afraid.”Skaret was lucky. Eventually, her body rid itself of the bacteria, and she escaped harm from a new type of superbug that scientists warn is spreading faster, further and in more alarming ways than any they’ve encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat.India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort.Medical TourismPoor hygiene has spread resistant germs into India’s drains, sewers and drinking water, putting millions at risk of drug-defying infections. Antibiotic residues from drug manufacturing, livestock treatment and medical waste have entered water and sanitation systems, exacerbating the problem.As the superbacteria take up residence in hospitals, they’re compromising patient care and tarnishing India’s image as a medical tourism destination.“There isn’t anything you could take with you traveling that would be useful against these superbugs,” says Robert Moellering Jr., a professor of medical research at Harvard Medical School in Boston.

-----------India is susceptible because it has many sick people to begin with. The country accounts for more than a quarter of the world’s pneumonia cases. It has the most tuberculosis patients globally and Asia’s highest incidence of cholera.Most of India’s 5,000-plus drugmakers produce low-cost generic antibiotics, letting users and doctors switch around to find ones that work. While that’s happening, the germs the antibiotics are targeting accumulate genes for evading each drug. That enables the bugs to survive and proliferate whenever they encounter an antibiotic they’ve already adapted to.India’s inadequate sanitation increases the scope of antibacterial resistance. More than half of the nation’s 1.2 billion residents defecate in the open, and 23 percent of city dwellers have no toilets, according to a 2012 report by the WHO and Unicef.Uncovered sewers and overflowing drains in even such modern cities as New Delhi spread resistant germs through feces, tainting food and water and covering surfaces in what Dartmouth Medical School researcher Elmer Pfefferkorn describes as a fecal veneer..

Michaela Cross, an American student at the University of Chicago, on her stay in India:

Do I describe the lovely hotel in Goa when my strongest memory of it was lying hunched in a fetal position, holding a pair of scissors with the door bolted shut, while the staff member of the hotel who had tried to rape my roommate called me over and over, and breathing into the phone?

How, I ask, was I supposed to tell these stories at a Christmas party? But how could I talk about anything else when the image of the smiling man who masturbated at me on a bus was more real to me than my friends, my family, or our Christmas tree? All those nice people were asking the questions that demanded answers for which they just weren't prepared.

When I went to India, nearly a year ago, I thought I was prepared. I had been to India before; I was a South Asian Studies major; I spoke some Hindi. I knew that as a white woman I would be seen as a promiscuous being and a sexual prize. I was prepared to follow the University of Chicago’s advice to women, to dress conservatively, to not smile in the streets. And I was prepared for the curiosity my red hair, fair skin and blue eyes would arouse.

But I wasn't prepared.

There was no way to prepare for the eyes, the eyes that every day stared with such entitlement at my body, with no change of expression whether I met their gaze or not. Walking to the fruit seller's or the tailer's I got stares so sharp that they sliced away bits of me piece by piece. I was prepared for my actions to be taken as sex signals; I was not prepared to understand that there were no sex signals, only women's bodies to be taken, or hidden away.

I covered up, but I did not hide. And so I was taken, by eye after eye, picture after picture. Who knows how many photos there are of me in India, or on the internet: photos of me walking, cursing, flipping people off. Who knows how many strangers have used my image as pornography, and those of my friends. I deleted my fair share, but it was a drop in the ocean-- I had no chance of taking back everything they took

For three months I lived this way, in a traveler's heaven and a woman's hell. I was stalked, groped, masturbated at; and yet I had adventures beyond my imagination. I hoped that my nightmare would end at the tarmac, but that was just the beginning. Back home Christmas red seemed faded after vermillion, and food tasted spiceless and bland. Friends, and family, and classes, and therapy, and everything at all was so much less real than the pain, the rage that was coursing through my blood, screaming so loud it deafened me to all other sounds. And after months of elation at living in freedom, months of running from the memories breathing down my neck, I woke up on April Fool's Day and found I wanted to be dead.

A 22-year-old photojournalist has been gang-raped by five men in the Indian city of Mumbai, police say.

The woman, who was on assignment on Thursday evening in the Lower Parel area when she was attacked, is in hospital with multiple injuries.

She was accompanied by a male colleague who was beaten by her attackers. Police have arrested one of the suspects.

In a similar case last December, a 23-year-old student was gang-raped on a bus in the capital, Delhi.

In that case, the woman and her male friend were brutally assaulted and she later died in hospital from her injuries.

The attack sparked nationwide protests and forced the authorities to introduce tougher laws for crimes against women.

'Reprehensible'The victim of Thursday's attack worked as an intern with a Mumbai-based English magazine and had gone to the Shakti Mills - a former textile mill that now lies abandoned and in ruins - for a photo shoot, police said.

She has been admitted to Jaslok hospital in Mumbai, which said that she was stable and able to speak.

"She went through a minor investigation procedure today [Friday] morning. She had both internal and external injuries," the statement said.

Hundreds of demonstrators have staged a silent protest in the city.

Mumbai police commissioner Satyapal Singh said the incident took place between "6pm and 6:30pm on Thursday" and described it as "reprehensible".

"The man [victim's male colleague] was clicking pictures on a camera while the girl was taking pictures on her mobile phone in the dilapidated building when one accused accosted them and inquired why they were there at the railway property," he said.

"He later called four more men to the spot. They tied the male colleague's hands with a belt and took the girl to the bushes and raped her."

Mr Singh said nearly 20 teams had been formed to investigate the case and that all the accused had been identified.

Earlier, police said 35 people had been detained and were being questioned. Sketches of the five accused were also released....

Commercial surrogacy in India has become a profiteering business with an annual earning of $1 billion.

Most pregnant mothers are kept in Shelter Homes during their days of confinement; critics have dubbed these homes as “baby factories”.

Why do women take such a step?

An 18-year-old surrogate mother Vasanti, said, “In India, relationships and family are very highly valued. One can do anything for one’s children. I have become a surrogate mother so that I can provide my children with all the very best in life, which I have only dreamed of.”

Vasanti is at present pregnant; but the child protected in her womb is not her own, instead it belongs to a Japanese couple. Vasanti shall be paid $8000 for her troubles.

Such a huge amount is like a dream to Vasanti, who can now build a new home and also educate her kids, who are seven and five years of age. With regards to the impending payment, Vasanti declared that she was extremely happy with the arrangement.

The “baby production” process

The procedure for injecting her womb with the embryo of the Japanese couple was undertaken in the Akanksha IVF Centre in Anand town of the Gujrat state. She has been moved to a nearby temporary shelter home provided by the centre, where she will continue to live for nine months.

This home houses a 100 other surrogate mothers just like Vasanti. All of these women are under the supervision of gynecologist, Doctor Nayana Patel.

Each room in the shelter home is allocated to 10 surrogate mothers, who are provided with food and vitamins. They are also instructed to rest regularly; Vasanti however does not rest that often.

“I keep roaming around here and there at night because I can’t sleep. As the child in my womb grows, I am beginning to get bored. I want to go home as soon as possible, back to my husband and children.”

According to the rules and regulations of the shelter home, pregnant surrogate mothers are prohibited from indulging in sexual acts. These women are also very explicitly told that in case of any complexities, the doctors, the parents who have donated the embryo(s) and the hospital will not be liable to pay for any damages.

If a surrogate mother carries twin embryos until the time of delivery she is paid $10,000 but if she suffers a miscarriage during the first three months, then she is only paid $600 for her troubles....

India, the second-largest exporter of over-the-counter and prescription drugs to the United States, is coming under increased scrutiny by American regulators for safety lapses, falsified drug test results and selling fake medicines.

Dr. Margaret A. Hamburg, the commissioner of the United States Food and Drug Administration, arrived in India this week to express her growing unease with the safety of Indian medicines because of “recent lapses in quality at a handful of pharmaceutical firms.”

India’s pharmaceutical industry supplies 40 percent of over-the-counter and generic prescription drugs consumed in the United States, so the increased scrutiny could have profound implications for American consumers.

F.D.A. investigators are blitzing Indian drug plants, financing the inspections with some of the roughly $300 million in annual fees from generic drug makers collected as part of a 2012 law requiring increased scrutiny of overseas plants. The agency inspected 160 Indian drug plants last year, three times as many as in 2009. The increased scrutiny has led to a flood of new penalties, including half of the warning letters the agency issued last year to drug makers.----------Enforcement of regulations over all is very weak, analysts say, and India’s government does a poor job policing many of its industries. Last month, the United States Federal Aviation Administration downgraded India’s aviation safety ranking because the country’s air safety regulator is understaffed, and a global safety group found that many of India’s best-selling small cars are unsafe.

India’s Central Drugs Standard Control Organization, the country’s drug regulator, has a staff of 323, about 2 percent the size of the F.D.A.'s, and its authority is limited to new drugs. The making of medicines that have been on the market at least four years is overseen by state health departments, many of which are corrupt or lack the expertise to oversee a sophisticated industry. Despite the flood of counterfeit drugs, Mr. Singh, India’s top drug regulator, warned in meetings with the F.D.A. of the risk of overregulation.

This absence of oversight, however, is a central reason India’s pharmaceutical industry has been so profitable. Drug manufacturers estimate that routine F.D.A. inspections add about 25 percent to overall costs. In the wake of the 2012 law that requires the F.D.A. for the first time to equalize oversight of domestic and foreign plants, India’s cost advantage could shrink significantly....

NEW DELHI: India has become heavily import dependent on China when it comes to many essential and large volume drugs making it vulnerable to sudden disruption of supplies, according to a study by Assocham.

Before #Nestle #Maggi Noodles Scare: Look at What the U.S. #FDA Found in #India made Snacks #Haldiram http://on.wsj.com/1GuQfQr via @WSJIndia

Indian regulators’ findings that samples of Nestlé SANESN.VX +0.24% Maggi instant noodles contained impermissibly high levels of lead stunned middle-class consumers this month. But long before India yanked the product off store shelves, U.S. food-safety inspectors had deemed hundreds of made-in-India snacks unfit for sale in America.

Data on the website of the U.S. Food and Drug Administration show that it rejected more snack imports from India than from any other country in the first five months of 2015. In fact, more than half of all the snack products that were tested and then blocked from sale in the U.S. this year were from India. Indian products led the world in snack rejects last year as well.

Mexico, a much larger trading partner of the U.S., was second in terms of rejections this year, followed by South Korea. China — whose exports to the U.S. are worth ten times as much as India’s — was a distant eighth.

And it’s not just snack foods. The U.S. FDA has rejected all sorts of imports from India, including everything from cosmetics to drugs to ceramics.

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Most Indian snacks rejected by the FDA this year were from the Nagpur-based food company Haldiram’s. Among the rejected Haldiram’s products were some sugar candies and salty Indian snack mixes. The FDA said on its website that it rejected the Haldiram’s products because it found pesticides in them.

A.K. Tyagi, a senior-vice president at Haldiram’s, said its food “is 100% safe and complies with the law of the land.” Discrepancies, he said, arise because food-safety standards differ in India and the U.S. “A pesticide that is permitted in India may not be allowed there. And even if it is, they may not allow it in the same concentration as it is here,” he said.

Indian baked snacks also had troubles getting into the States. Out of 217 imported baked products rejected by the U.S. FDA so far this year, more than half were made in India. One of them was a biscuit pack manufactured by India’s largest biscuit-maker, Britannia Industries Ltd.

Reddy- one of #India's largest drugmakers is crashing after the #US #FDA warning on quality http://read.bi/1Prz0Ua via @bi_contributors

Dr Reddy's Laboratories Ltd, India's second-largest drugmaker, has received a "warning letter" from US regulators over inadequate quality controls at three manufacturing plants producing drugs for cancer and other diseases.

The warning is the latest in a string of incidents that have hurt the industry's reputation and slowed its growth in the world's largest drug market, where India supplies more than 40% of the generic and over-the-counter medicines.

Dr Reddy's said the FDA warning meant it would not receive US approvals for drugs made at the plants until it fixed the problems, a blow for business at a company that relies on the US for a majority of its sales.

The affected plants account for more than 10% of the company's sales.

Dr Reddy's said a production halt may not be required, but the news caught investors by surprise, sending shares to their lowest level in four months.

"We are probably looking at flat to declining earnings in FY 2017, while earlier we were expecting growth," said analyst Nimish Mehta, founder of Research Delta Advisors.

Analysts warned the move by the US Food and Drug Administration would hit US sales for at least the next two years, as the launch of key products may be delayed.

"There is no indication in the warning letter that we need to stop manufacturing, but we will be examining the contents and deciding our strategy," Dr Reddy's CFO Saumen Chakraborty told the Indian television news channel ET Now.

The FDA inspected the company's Srikakulam, Miryalaguda, and Duvvada drug-manufacturing sites in November, January, and February, and it almost immediately issued initial notices asking the group to rectify some problems.

But the company was unable to fix the issues to the satisfaction of the FDA, and it was hit with a warning letter. Such letters are issued by the agency when it finds a manufacturer has "significantly violated" its regulations.

"We had absolutely no idea it could escalate to this level," Siddhanth Khandekar of ICICI Securities said.

Dr Reddy's said the agency's concerns with the plants related to quality-control procedures and how data was recorded. It did not provide details.

The FDA has already banned plants of other Indian firms, such as Wockhardt Ltd and Ranbaxy Laboratories Ltd, a unit of the country's largest drugmaker Sun Pharmaceutical Industries Ltd, after finding faulty, fudged, or incomplete data records in recent years.

Both companies have been unable to get their plants cleared by the agency, more than two years after the bans.

But analysts say the FDA considers data integrity issues to be the most serious, typically requiring at least two years to be remedied to its satisfaction.

Dr Reddy's CEO G V Prasad said the group was revamping its quality systems as a result.

The FDA has increased the number of inspections of foreign plants supplying to the US over the past year, exposing quality-control issues at several Indian drugmakers. India plants of multinational drugmakers, such as Novartis and Mylan, have also come under fire.

Industry executives say they have been improving their manufacturing and systems, but sanctions continue.

Dr Reddy's makes drug ingredients at the Srikakulam and Miryalaguda plants, and cancer medicines at the Duvvada plant.

Sun Pharmaceutical Industries Ltd., India’s largest drugmaker by sales, said Saturday that one of its factories is under increased scrutiny from U.S. regulators.

The generic-drug maker’s factory in Halol, in the western Indian state of Gujarat, received a warning letter from the U.S. Food and Drug Administration. Warning letters are issued when the FDA isn't satisfied with a drugmaker’s plan to fix quality issues spotted by the regulator.

This is the latest setback for India’s pharmaceutical companies, which have struggled with quality issues under the increased scrutiny from the FDA. Indian companies account for around 40% of generic drug sales in the U.S.

U.S. inspectors in September last year said they were concerned with how Sun Pharma workers at its plant handled quality-test data and the plant’s “sterile environment,” said Dilip Shanghvi, Sun Pharma’s managing director.

If Sun Pharma is unable to assure the FDA that it can fix the problems, the regulator will issue an import alert, barring that factory from producing medicines for the U.S.

Sun Pharma makes some of its most profitable products at the Halol factory, including pre-filled syringes that need to manufactured in a sterile environment.

The Halol factory is continuing to produce drugs as it tries to fix quality issues, better train its staff and automate more of the manufacturing process, Mr. Shanghvi said.

The company has already moved production of some of the drugs produced at Halol to mitigate any impact on sales should the Halol plant be unable to export to the U.S., he said.

A deadly epidemic that could have global implications is quietly sweeping India, and among its many victims are tens of thousands of newborns dying because once-miraculous cures no longer work.

These infants are born with bacterial infections that are resistant to most known antibiotics, and more than 58,000 died last year as a result, a recent study found. While that is still a fraction of the nearly 800,000 newborns who die annually in India, Indian pediatricians say that the rising toll of resistant infections could soon swamp efforts to improve India’s abysmal infant death rate. Nearly a third of the world’s newborn deaths occur in India.

“Reducing newborn deaths in India is one of the most important public health priorities in the world, and this will require treating an increasing number of neonates who have sepsis and pneumonia,” said Dr. Vinod Paul, chief of pediatrics at the All India Institute of Medical Sciences and the leader of the study. “But if resistant infections keep growing, that progress could slow, stop or even reverse itself. And that would be a disaster for not only India but the entire world.”

In visits to neonatal intensive care wards in five Indian states, doctors reported being overwhelmed by such cases.

“Five years ago, we almost never saw these kinds of infections,” said Dr. Neelam Kler, chairwoman of the department of neonatology at New Delhi’s Sir Ganga Ram Hospital, one of India’s most prestigious private hospitals. “Now, close to 100 percent of the babies referred to us have multidrug resistant infections. It’s scary.”

These babies are part of a disquieting outbreak. A growing chorus of researchers say the evidence is now overwhelming that a significant share of the bacteria present in India — in its water, sewage, animals, soil and even its mothers — are immune to nearly all antibiotics.

Newborns are particularly vulnerable because their immune systems are fragile, leaving little time for doctors to find a drug that works. But everyone is at risk. Uppalapu Shrinivas, one of India’s most famous musicians, died Sept. 19 at age 45 because of an infection that doctors could not cure.

“India’s dreadful sanitation, uncontrolled use of antibiotics and overcrowding coupled with a complete lack of monitoring the problem has created a tsunami of antibiotic resistance that is reaching just about every country in the world,” said Dr. Timothy R. Walsh, a professor of microbiology at Cardiff University.

Indeed, researchers have already found “superbugs” carrying a genetic code first identified in India — NDM1 (or New Delhi metallo-beta lactamase 1) —around the world, including in France, Japan, Oman and the United States.

Anju Thakur’s daughter, born prematurely a year ago, was one of the epidemic’s victims in Amravati, a city in central India. Doctors assured Ms. Thakur that her daughter, despite weighing just four pounds, would be fine. Her husband gave sweets to neighbors in celebration.

Three days later, Ms. Thakur knew something was wrong. Her daughter’s stomach swelled, her limbs stiffened and her skin thickened — classic signs of a blood infection. As a precaution, doctors had given the baby two powerful antibiotics soon after birth. Doctors switched to other antibiotics and switched again. Nothing worked. Ms. Thakur gave a puja, or prayer, to the goddess Durga, but the baby’s condition worsened. She died, just seven days old.

In a country with the world's heaviest health burden, and highest rates of death from treatable diseases like diarrhea, tuberculosis and pneumonia, corruption at medical schools is an extremely pressing issue. The Indian Medical Association estimates that nearly half of those practicing medicine in the country do not have any formal training, but that many of those who claim to be qualified may actually not be.

a couple of recent studies and reports have cast serious doubts on the quality and ethics of the country's vast medical schooling system. The most recent revealed that more than half of those 579 didn't produce a single peer-reviewed research paper in over a decade (2005-2014), and that almost half of all papers were attributed to just 25 of those institutions.

The 2011 court case against a man, Balwant Arora, was one of the earlier indications of the massive levels of fraud. Arora brazenly admitted to issuing more than 50,000 fake medical degrees at around $100 apiece from his home, saying that each of the recipients had "some medical experience" and that he was doing it in service to a country that desperately needs more doctors. He had served four months in jail in 2010 for similar offences.

Private medical colleges have proliferated rapidly in India. When in 1980 there were around 100 public colleges and 11 private, the latter now outnumber the former by 215 to 183. Most are run by businessmen with no medical experience. Last January, the British Medical Journal found that many private medical colleges charged "capitation" fees, which are essentially compulsory donations required for admission. Jeetha D'Silva, who authored that report, wrote, "Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson's choice — either pay capitation to secure admission at a college or give up on the dream of a medical degree."

The best public medical colleges have acceptance rates that are minuscule, even compared to Ivy League universities. Those colleges also tend to be the ones that produce the most research papers, as well as handle the most patients, which would seem to eliminate the possible excuse that overwhelming patient burdens prevent private colleges from producing valuable research.

The most productive medical college in India is also its largest public health institution, the All India Institute of Medical Sciences, or AIIMS. In the 10-year period that Samiran Nundy and his colleagues examined, AIIMS published 11,300 research papers. For context, that is about a quarter of what Massachusetts General Hospital produced in the same time frame.

The Saudi German Hospitals (SGH) group will build and manage hospitals in Bahria Town gated-communities in Pakistan, top management of the two companies announced on Thursday in Dubai.

The partnership will revolutionise Pakistan’s health care sector, eliminating the need for Pakistanis to travel to the West for treatment, Riaz Malik, chairman of Bahria Town, said at a press conference at Saudi German Hospital Dubai, where Sobhi Batterjee, president of Bait Al Batterjee (BAB) Medical Company, the founder of SGH, also spoke.

Under the agreement, SGH will build a 150-300 bed hospital in each Bahria Town development, starting with Lahore, Karachi and Islamabad in the first stage. BAB will also take over the upcoming new hospital of Bahria Town in Lahore as an operator and possibly also manage all hospitals of Bahria Town.

Each SGH-built hospital will have an investment of $100 million (Dh367 million), Batterjee said, and be built on a 12-acre plot of land provided for free in Bahria Town communities.

Malik said Bahria Town hospitals “will not stop treatment because of [patients’] financial problems. Bahria Town will put in its own money [to cover the remaining cost]”.

Batterjee said the partnership will lead to “reverse medical tourism” where patients and doctors from outside Pakistan will travel to SGH and SGH-managed hospitals in Pakistan. He said SGH’s foray in Pakistan will set a benchmark to which all other health care facilities will be compared.

“This will increase the corporate investment injection into health care, which is missing in Pakistan. Health care is an industry in itself, many people miss that fact,” Batterjee added.

Malik said Bahria Town hospitals meanwhile will gain from the 30-year expertise of SGH. “Unfortunately, there are too many health issues in Pakistan. We wanted to focus on this sector and after researching for the best health care provider, we found that SGH would be our ideal partner,” Malik added. “We are one team and I commit to giving Pakistan the best treatment ever,” said Batterjee.

A grieving man in India carried his wife's body for miles after the hospital where she died allegedly failed to provide a way to transport her body back to their village.

Without the money to hire a vehicle, Dana Manjhi walked for 6.2 miles (10 kilometers) by foot Wednesday.In the humid and sweltering summer temperatures, he hoisted his wife's body, wrapped in a blue sheet, over his shoulder. He was accompanied by his weeping 12-year-old daughter.His wife, Amang Dei, 42, died of tuberculosis Tuesday night at a hospital in the eastern state of Odisha.On-lookers interveneManjhi and his daughter had about 50 kilometers (31 miles) to go before reaching their village when passersby called a local journalist.Odisha TV journalist Ajit Singh found them and recorded video of the pair that has been widely-shared across the nation."I am carrying the dead body of my wife as I am poor and cannot afford a vehicle. I told the same to the hospital authorities. They said they could not offer any help," Manjhi said in the video.Singh described the story to CNN."Some locals ... spotted Mr. Manjhi carrying the dead body of his wife accompanied by his 12-year-old daughter, Sanadei Manjhi, and called me," he said. "We filmed him carrying the dead body and asked him what happened.A car was eventually organized for Manjhi.

A government-provided transport van should have been available to Manjhi, affiliate CNN News 18 reported. However, he said he was refused help and told by the hospital to take the body and leave.The hospital denied reports it withheld a car from him. A hospital official told CNN they did not even know when Manjhi took his wife's body."No one knows when her husband carried her out of the hospital," said Dr. Jaghu Lal Agarwal, assistant district medical officer at the Kalahandi hospital."Her death was not confirmed by the on-duty doctor and no discharge slip was issued. The hospital staffs on duty were not informed by Mr. Manjhi."A government inquiry had been launched into the incident, said Brundha D, a district official."We have ordered a probe and due actions will be taken if any wrongdoing has been done," she said.Odisha is one of the remotest states in India. A 2011 UN report that examined 19 Indian states gave it the lowest ranking on the Human Development Index.India ranks 106 out of 140 countries for health care, according to the World Economic Forum Global Competitiveness Index.

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I am the Founder and President of PakAlumni Worldwide, a global social network for Pakistanis, South Asians and their friends. I also served as Chairman of the NEDians Convention 2007. In addition to being a South Asia watcher, an investor, business consultant and avid follower of the world financial markets, I have more than 25 years experience in the hi-tech industry. I have been on the faculties of Rutgers University and NED Engineering University and cofounded two high-tech startups, Cautella, Inc. and DynArray Corp and managed multi-million dollar P&Ls. I am a pioneer of the PC and mobile businesses and I have held senior management positions in hardware and software development of Intel’s microprocessor product line from 8086 to Pentium processors. My experience includes senior roles in marketing, engineering and business management. I was recognized as “Person of the Year” by PC Magazine for my contribution to 80386 program. I have an MS degree in Electrical engineering from the New Jersey Institute of Technology.
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